Current statistics clarify the burden of extant and emerging WOC nursing needs. It is estimated that five million Americans have chronic wounds, with 1.5 million to 1.8 million new wound cases added each year.³ Pressure ulcers, in particular, have a prevalence rate of up to 10% in the acute care setting and up to 28% in long-term care.⁴ Half a million Americans currently have a stoma and require teaching, counseling, and supportive care. Over 11 million Americans suffer from documented urinary incontinence, and it’s likely that more are hiding their problem.⁵ The incidence and prevalence of all these disorders is guaranteed to intensify given the rapid increase of elderly Americans, especially those above 85 years. In short, WOC nurses will never run out of patients.

What? Where? How?

What is WOC nursing? Where is WOC nursing practiced? How does a nurse specialize in this area? What are the educational and clinical practice requirements? WOC nursing is practiced by registered nurses who specialize in the acute and rehabilitative care of patients with disorders of the integumentary, gastrointestinal, and genitourinary systems. The typical WOC nurse is baccalaureate prepared, has at least five years of experience in nursing practice, demonstrates strong leadership capabilities, and has completed a formal WOCN-accredited education program. Specific functions of the WOC nurse include direct patient care, consultation, staff and patient education, and maintenance of an evidenced-based practice through use of and involvement in research studies.⁶ The scope of practice for WOC nurses includes care of patients with abdominal stomas, wounds, fistulas, drains, pressure ulcers, and urinary and fecal incontinence. As clinicians, educators, researchers, consultants, and administrators, WOC nurses play pivotal roles in enabling patients to reach their highest rehabilitative potential.⁶

WOC nurses practice in all care settings and across the care continuum. On the same day, for example, a WOC nurse may provide consultation for an infant with an ostomy due to imperforate anus, an elderly person with urinary incontinence due to neurogenic bladder, and a middle-aged man scheduled for neobladder construction because of bladder cancer. Similarly, WOC nurses may practice in a hospital setting or function as a resource for home care agencies. They may also provide guidance for extended care facilities or outpatient clinics.

How does an interested nurse become a specialist in WOC care? The educational and clinical requirements are established by WOC nurses’ professional association, the Wound, Ostomy, Continence Nurses (WOCN) Society. The WOCN Society currently specifies that nurses can become eligible for the national certification examination through three paths: attending a WOCN-accredited education program; completing a master’s degree focusing on wound, ostomy, or continence (WOC) practice; or completing more than 2,000 hours of WOC clinical practice.⁷ Overwhelmingly, neophyte WOC nurses attend a WOCN-accredited educational program.

Requirements for the WOCN educational programs (WOCNEPs) include RN license; baccalaureate degree in nursing; or RN with a non-nursing baccalaureate degree with demonstrated competencies in health assessment, community health, research/statistics, and management (usually validated by standardized examination or college courses).⁸ Currently, eight WOCNEPs exist nationally with a variety of learning formats (onsite, distance learning) and educational outcomes, e.g., college credits, CEUs, etc.⁷ All programs, however, must spend at least 120 hours of didactic focus on WOC nursing care issues and require a minimum of 120 hours of a clinical practicum with an experienced, credentialed preceptor.

Because WOC nursing is developing with the larger context of American healthcare, WOC nurses are increasingly expected to acquire advanced practice education.^9,10 Most contemporary advanced practice nursing (APN) WOC specialists are functioning as either clinical nurse specialists or nurse practitioners.¹¹ Their patient care include the specialist knowledge provided by WOC education plus the comprehensive abilities of the APN, including prescriptive privileges. Two WOCNEPs have addressed this evolution to advanced practice: the University of Southern California and La Salle University School of Nursing WOCNEP. Both permit nurses to become eligible for WOC certification examination and gain graduate credit simultaneously.

The Future of WOC Nursing

If global trends and past history are indicators of what is yet to come, then WOC nurses are likely to be in great demand for the foreseeable future. They care for all age groups, they are versatile across care settings, and they teach for both prevention of disease and/or institution of care to promote rehabilitation. WOC nurses are and will be increasingly valuable to American society because they help ensure quality nursing outcomes for the American people; they assist with healthcare cost control; and they provide, amid the technology, the necessary human touch for people needing comprehensive wound, ostomy, or continence care in the new millennium.

Nurses interested in learning about WOC nursing can contact the National WOCN Society at (888) 224-WOCN, consult their website at www.wocn.org (check the education section for the accredited WOCNEPs), consult the Journal of WOCN (available in most nursing and healthcare libraries), or contact me at (215) 951-1430.

Janice M. Beitz, RN, PhD, CS, CNOR, CWOCN, associate professor, graduate program director, WOCNEP codirector, La Salle University School of Nursing, Philadelphia, PA.

References

1. Porter-O’Grady T. A glimpse into the new millennium: a new era for health care. Today’s OR Nurse. 1999;May/June, 24-29.

2. Vezeau T, Peterson J, Nakao C, Ersek M. Education of advanced practice nurses: serving vulnerable populations. Nursing & Health Care Perspectives. 1998;19(3);124-131.

3. Tallon R. Critical paths for wound care. Advances in Wound Care. 1995l8(1): 26-34.

4. Bergstrom N, Bennett MA, Carlson CE, et al. Treatment of Pressure Ulcers. Clinical Practice Guideline No.15. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service, Agency for Health Care Policy and Research; 1994

5. Doughty D. Urinary and Fecal Incontinence. 2nd ed. St. Louis, MO: C.V. Mosby; 1999

6. Wound, Ostomy, Continence Nurses Society. Mission, Role, and Scope. Laguna Beach, CA: The Society; 1998.

7. WOCN-accredited professional education programs. J WOCN. 2000;27(1), 29A-30A.

8. Wound, Ostomy, Continence Nurses Society. WOCN Accreditation Policy and Procedure Manual. Laguna Beach, CA: The Society; 2000.

9. Doughty D. Integrating advanced practice and WOC nursing education. J WOCN. 2000;27(1):65-68.

10. Gray M, Ratliff C, Mawyer R. A brief history of advanced practice nursing and its implications for WOC advanced nursing practice. J WOCN. 2000; 27(1): 48-54.

11. Beitz J. Specialty practice, advanced practice, and WOC nursing: current professional issues, and future opportunities. J WOCN. 2000;27(1):55-64.